{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:13:23Z","timestamp":1790010803531,"version":"4.0.1"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T00:00:00Z","timestamp":1710460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T00:00:00Z","timestamp":1710460800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this study is to evaluate the in vivo medial and lateral joint laxities across various total knee arthroplasty (TKA) alignment categories correlated to (1) hip\u2013knee\u2013ankle angle, (2) proximal tibial angle\u00a0and (3) distal femoral angle in a consecutive group of patients undergoing robotic\u2010assisted TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using ligament tensions acquired during 805 robotic\u2010assisted TKA with a dynamic ligament tensor under a load of 70\u201390\u2009N, the relationship between medial and lateral collateral ligament laxity and overall limb alignment was established. Only knees with neutral or mechanical varus alignment were included and divided into five\u00a0groups: neutral (0\u00b0\u20133\u00b0), varus 3\u00b0\u20135\u00b0, varus 6\u00b0\u20139\u00b0, varus 10\u00b0\u201313\u00b0 and varus \u226514\u00b0. Groups were further subdivided by the intraoperative medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA). The distraction of the medial and lateral sides was compared across the various alignments using an analysis of variance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The ability to distract the medial collateral ligament in extension and flexion was proportional to the degree of varus deformity, increasing from 4.0\u2009\u00b1\u20092.3\u2009mm in the neutral group to 8.7\u2009\u00b1\u20093.2\u2009mm in the varus \u226514\u00b0 group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). On the lateral side, the distraction of the lateral collateral ligament decreased in both extension (2.2\u2009\u00b1\u20092.4 vs. 1.2\u2009\u00b1\u20092.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) and flexion (2.8\u2009\u00b1\u20092.8 to 1.7\u2009\u00b1\u20093.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) with increasing native varus deformity. MPTA and LDFA had similar effects, where increasing MPTA varus and LDFA valgus increased medial distractibility in extension and flexion. There was significant variability of the stretch of the ligaments within and across all alignment categories, in which the standard deviation of the groups ranged from 2.0 to 3.0\u2009mm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates increased medial ligament distractibility with increasing varus deformity. However, there was significant variability in ligamentous laxity within various limb alignment categories suggesting the anatomy and soft tissue identity of the knee is complex and highly variable. TKAs seeking to be more anatomic will not only need to restore alignment but also native soft tissue tensions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, prognostic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.12115","type":"journal-article","created":{"date-parts":[[2024,3,16]],"date-time":"2024-03-16T02:16:19Z","timestamp":1710555379000},"page":"1516-1524","source":"Crossref","is-referenced-by-count":33,"title":["Alignment is only part of the equation: High variability in soft tissue distractibility in the varus knee undergoing primary TKA"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0457-7371","authenticated-orcid":false,"given":"Matthew J.","family":"Grosso","sequence":"first","affiliation":[{"name":"Connecticut Joint Replacement Institute Hartford Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar A.","family":"Wakelin","sequence":"additional","affiliation":[{"name":"Corin Group Raynham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Plaskos","sequence":"additional","affiliation":[{"name":"Corin Group Raynham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwo\u2010Chin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hospital for Special Surgery New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,15]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","first-page":"7","article-title":"Osteoarthrosis of the knee. 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